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Published on: February 9, 2011
Safety of Nurse- and Self-Administered Paediatric Outpatient Parenteral Antimicrobial Therapy
Shanthy Sriskandarajah1, Brett Ritchie2, Janet K Sluggett3,4,5
1Medical Device Research Institute, College of Science and Engineering, Flinders University, GPO Box 2100, Adelaide 5001, South Australia, Australia.
Insights
Self-administering paediatric outpatient parenteral antimicrobial therapy (OPAT) at home increased the risk of adverse events (AEs) compared to nurse-administered care. Longer vascular access duration also correlated with higher AE incidence in pediatric OPAT.
Area of Science:
- Pediatric Infectious Diseases
- Pharmacology
- Healthcare Delivery Models
Background:
- Outpatient parenteral antimicrobial therapy (OPAT) is increasingly utilized in pediatric care.
- Understanding the safety and efficacy of different OPAT administration models is crucial for optimizing patient outcomes.
- Adverse events (AEs) are a significant concern in pediatric OPAT, necessitating identification of associated risk factors.
Purpose of the Study:
- To compare the safety and efficacy of nurse- vs. self-administered pediatric outpatient parenteral antimicrobial therapy (OPAT).
- To identify clinical factors associated with documented adverse events (AEs) in pediatric OPAT.
- To evaluate the incidence and types of AEs in different pediatric OPAT models.
Main Methods:
- Retrospective review of 100 pediatric OPAT episodes (children aged 1 month to 18 years) receiving continuous 24-hour intravenous antimicrobial therapy at home.
- Classification of documented AEs as major or minor by a pediatrician.
- Multivariable logistic regression analysis to determine associations between clinical factors and AEs.
Main Results:
- Overall, 27% of OPAT episodes had a recorded AE, with 15 major and 14 minor AEs.
- Self-administration was associated with a significantly increased odds of an AE (aOR 6.25).
- Longer duration of vascular access (>14 days) also increased the odds of an AE (aOR 1.08).
Conclusions:
- Self-administration of pediatric OPAT via continuous 24-hour infusions may lead to a higher frequency of minor adverse events.
- Careful patient selection and monitoring are essential for self-administered pediatric OPAT.
- Optimizing vascular access duration may help mitigate AE risk in pediatric OPAT.
Abstract:
This study aimed to compare and contrast the safety and efficacy of nurse- and self-administered paediatric outpatient parenteral antimicrobial therapy (OPAT) models of care and to identify clinical factors associated with documented adverse events (AEs). A total of 100 OPAT episodes among children aged between 1 month and 18 years who were discharged from hospital and who received continuous 24 h intravenous antimicrobial therapy at home via an elastomeric infusion device were included. All documented AEs from the case notes were reviewed by a paediatrician and classified as either major or minor. Multivariable logistic regression was used to determine associations between clinical factors and any AE. A total of 86 patients received 100 treatment OPAT episodes (49 self-administered, 51 nurse administered). The most commonly prescribed antimicrobial via continuous infusion was ceftazidime (25 episodes). Overall, an AE was recorded for 27 (27%) OPAT episodes. Major AEs was recorded for 15 episodes and minor AEs were reported in 14 episodes. The odds of an AE was increased in episodes with self-administration (adjusted odds ratio (aOR) 6.25, 95% confidence interval (CI) 1.44-27.15) and where the duration of vascular access was >14 days (aOR 1.08, 95%CI 1.01-1.15). Our findings suggest minor AEs may be more frequently reported when intravenous antimicrobials are self-administered via 24 h continuous infusions.
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